Emergency Medicine Palliative Care Access (EMPallA): protocol for a multicentre randomised controlled trial comparing the effectiveness of specialty outpatient versus nurse-led telephonic palliative care of older adults with advanced illness. Issue 1 (25th January 2019)

• Record Type: Journal Article
• Authors: Grudzen, Corita R; Shim, Deborah J; Schmucker, Abigail M; Cho, Jeanne; Goldfeld, Keith S
• Other Names: author non-byline.; Rubin Caroline Blaum Ada L author non-byline.; Southerland Lauren author non-byline.; Caterino Jeffrey M author non-byline.; Ouichi Kei author non-byline.; Elie Marie-Carmelle author non-byline.; Swor Robert author non-byline.; Jubanyik Dokaren author non-byline.; Cohen Susan E author non-byline.; Kim Arum author non-byline.; Lowy Joseph author non-byline.; Scherer Jennifer S author non-byline.; Bael Nancy E author non-byline.; Gafford Ellin author non-byline.; Lakin Joshua author non-byline.; Barker Paige author non-byline.; Chmielewski Angela author non-byline.; Kapo Jennifer author non-byline.; Tan Audrey author non-byline.; Brody Doabraham author non-byline.; Yamarik Rebecca author non-byline.; Salz Susan author non-byline.; Ryan Stephen author non-byline.; Kim Anne author non-byline.; Castro Isabel author non-byline.; Hill Michael author non-byline.; Hargrove Amelia author non-byline.; Stuecher Laura author non-byline.; Daut Nora author non-byline.; Bakitas Marsack author non-byline.; Batra Faanromilla author non-byline.; Booker-Vaughns Juanita author non-byline.; Sadasivan Meddonna C author non-byline.; Chan Garrett K author non-byline.; Dionne-odom J Nicholas author non-byline.; Dunn Patrick author non-byline.; Galvin Robert author non-byline.; Hopkins III Ernest A author non-byline.; David Isaacs author non-byline.; Kizzie-Gillet author non-byline.; Maguire Margaret M author non-byline.; Pidatala Neha Reddy author non-byline.; Rosini Dawn author non-byline.; Vaughan author non-byline.; Welsh Sally author non-byline.; Williams author non-byline.; Young-Brinn author non-byline.;
• Is Part Of: BMJ open. Volume 9:Issue 1(2019)
• Publication Date: 2019-01-25
• Subjects: palliative care -- randomised controlled trial -- older adults -- advanced illness -- comparative effectiveness -- emergency department; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2018-025692
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Introduction: Emergency department (ED)-initiated palliative care has been shown to improve patient-centred outcomes in older adults with serious, life-limiting illnesses. However, the optimal modality for providing such interventions is unknown. This study aims to compare nurse-led telephonic case management to specialty outpatient palliative care for older adults with serious, life-limiting illness on: (1) quality of life in patients; (2) healthcare utilisation; (3) loneliness and symptom burden and (4) caregiver strain, caregiver quality of life and bereavement. Methods and analysis: This is a protocol for a pragmatic, multicentre, parallel, two-arm randomised controlled trial in ED patients comparing two established models of palliative care: nurse-led telephonic case management and specialty, outpatient palliative care. We will enrol 1350 patients aged 50+ years and 675 of their caregivers across nine EDs. Eligible patients: (1) have advanced cancer (metastatic solid tumour) or end-stage organ failure (New York Heart Association class III or IV heart failure, end-stage renal disease with glomerular filtration rate <15 mL/min/m 2, or global initiative for chronic obstructive lung disease stage III, IV or oxygen-dependent chronic obstructive pulmonary disease); (2) speak English; (3) are scheduled for ED discharge or observation status; (4) reside locally; (5) have a working telephone and (6) are insured. Patients will be excluded if they: (1) have dementia; (2) have received hospice care or two or more palliative care visits in the last 6 months or (3) reside in a long-term care facility. We will use patient-level block randomisation, stratified by ED site and disease. Effectiveness will be compared by measuring the impact of each intervention on the specified outcomes. The primary outcome will measure change in patient quality of life. Ethics and dissemination: Institutional Review Board approval was obtained at all study sites. Trial results will be submitted for publication in a peer-reviewed journal. Trial registration number: NCT03325985 ; Pre-results.